In this day and age, Picture Archiving and Communication Systems (PACS) are essential for providing images immediately and anywhere. Main Line Health System Enterprise Imaging Administrator Ken Olbrish understands that firsthand.
Main Line Health System, located outside of Philadelphia, successfully completed an enterprise PACS implementation. We sat down with Olbrish to discuss lessons learned from the PACS implementation.
When a PACS must be integrated with other devices, what challenges do administrators face?
There are several challenges for PACS administrators to overcome.
First, there is the initial set up. It would be nice to believe that devices are all standardized in terms of their interfaces because they utilize existing standards such as DICOM or HL7. While these standards help to get device integration working at a basic level, vendors may choose to implement these standards differently or choose to implement only certain aspects of these standards. As a result a PACS administrator may find that while a device can communicate, not all the information that is needed is present in the transactions or images, or data may not appear consistently across devices.
Second, there is an ongoing problem of having to deal with differences in versions. In an ideal environment, all similar devices would be upgraded at the same time. But it is not uncommon that a hospital or healthcare enterprise could have several of the same devices all operating on different software platforms or versions because of the timing on when they were implemented, when money was available for upgrades, when devices were available for upgrades, etc. PACS administrators must be constantly aware of changes being made to existing devices to ensure they are tracked and integration is tested following updates.
How can these challenges be overcome?
For all of the integration challenges outlined above, there are several basic things a PACS administrator can do to address them:
- Attempt to schedule defined time for integration and testing into the PACS implementation project timeline. This obviously doesn’t ensure the time will be available when it is time for the integration if there are earlier delays in the project, but it does at least help to ensure that time is allocated for the integration. If nothing more, this will raise awareness within the organization as to how much time it takes to perform the integration.
- Maintain current documentation that outlines versions and other relevant information. By tracking this information, a PACS administrator may have a better handle on what devices may behave differently and have information necessary to work with vendors on resolving integration issues.
- Create a test environment and test as thoroughly as possible before new implementations and upgrades. A PACS administrator should create test scripts for each integration that can then be updated and reused for subsequent upgrades over time. By working out integration issues in a test environment, there is less likelihood that issues will arise in a production environment. It is extremely helpful to get key users engaged in the testing, whether these are physicians, technologists or other super users of the systems involved.
What are a few of your top tips to ensure a smooth PACS implementation?
1. Assess user needs and requirements before the PACS implementation begins. To obtain user buy-in, the users need to be engaged in the process and feel that their needs are being met through the implementation of whatever system is ultimately selected and implemented. When assessing user needs, it is also important to include representatives from all impacted areas.
2. Look at workflow and processes as much as or more than the system being selected. System implementations often fail not because the system doesn’t work, but because the processes associated with using the system fail. Trying to duplicate inefficient or bad processes with new systems or technology leads to failure.
3. Include more training in the rollout than you think you need. When systems are implemented and there is not enough training, it limits the likelihood of success. An environment and schedule need to be created to allow users to attend training and not be rushed or interrupted during training. Furthermore, training often works better when it is spread over time. Initially users will just need to learn the basics of the system. But after several weeks or months of using the system, users will most likely need additional training to take their use of the system to another level.
4. Budget accordingly in terms of costs and time. Estimating capital costs for a new PACS implementation is easy. Estimating ongoing operating costs, costs for professional services, costs for integration, etc., are much more difficult to assess without proper planning. Sites often look at PACS needs at the time of implementation, but fail to look at more long-term needs. For instance, it may take only one or two resources to support a PACS initially. But if use of the PACS expands significantly for referring physicians or multiple clinical areas, or additional support responsibilities are added for those resources, then more PACS support resources may be needed in subsequent years. These should be included in the initial planning.